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Clinical Parasitology 08

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Parasitic Infections: Clinical Manifestations, Diagnosis and Treatment Lennox K. Archibald, MD, PhD, FRCP, DTM&H Hospital Epidemiologist University of Florida
The Reality ,[object Object],[object Object],[object Object],[object Object]
Case1 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Case 1 ,[object Object],[object Object],[object Object]
 
 
Diagnosis?
Giardiasis ( G. lamblia ) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Giardiasis Tests of choice ,[object Object],[object Object],[object Object],[object Object],[object Object]
Case 2 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Case 2 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Sigmoidoscopy revealed… ,[object Object],[object Object]
Case 2 ,[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
Diagnosis?
Entamoeba histolytica ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Trophozoites with ingested RBC
Trophozoites in colon tissue (H & E stain)
Cyst (wet mount)
Amoebiasis: Clinical Manifestations ,[object Object],[object Object],[object Object],[object Object]
Amoebiasis: Clinical Manifestations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Amoebic abscess—remember… ,[object Object]
Amoebic Abscess ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
Remember… ,[object Object],[object Object],[object Object],[object Object]
Amoebiasis Treatment ,[object Object],[object Object]
Case 3 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Case 4 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Diagnosis? Case 3 & 4
Three cysts stained pale red are seen in the center with this acid fast stain
Modified acid-fast stain of stool showing red oocysts of Cryptosporidium parvum against the blue background of coliforms and debris
Cryptosporidium parvum ,[object Object],[object Object],[object Object],[object Object]
Cryptosporidium parvum ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Diagnosis and Treatment ,[object Object],[object Object],[object Object]
Case 5 ,[object Object],[object Object],[object Object],[object Object],[object Object]
Case 5 ,[object Object],[object Object],[object Object]
Case 5 ,[object Object],[object Object]
 
 
Falciparum vs. Vivax ,[object Object],[object Object],[object Object]
 
 
Malaria: Genetic susceptibility ,[object Object],[object Object],[object Object],[object Object],[object Object]
Malaria: Clinical manifestations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Malaria: Clinical manifestations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Malaria: Clinical manifestations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Malaria: Clinical manifestations ,[object Object],[object Object],[object Object],[object Object]
Diagnosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Differences in strains ,[object Object],[object Object],[object Object],[object Object]
Differences in strains ,[object Object],[object Object],[object Object],[object Object],[object Object]
Differences in strains ,[object Object],[object Object],[object Object],[object Object]
Treatment ,[object Object],[object Object],[object Object]
Treatment Uncomplicated malaria ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Treatment Severe malaria ,[object Object],[object Object],[object Object]
Prevention ,[object Object],[object Object],[object Object],[object Object],[object Object]
And don’t forget baggage malaria!
Case 5 ,[object Object],[object Object],[object Object],[object Object]
Case 6 ,[object Object],[object Object],[object Object],[object Object]
Case 6 ,[object Object],[object Object],[object Object]
 
Diagnosis?
 
An intact macrophage practically filled with amastigotes (arrows),
Leishmaniasis ,[object Object],[object Object]
Leishmaniasis ,[object Object],[object Object],[object Object],[object Object],[object Object]
Leishmaniasis: Diagnosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Visceral Leishmaniasis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Hepatosplenomegaly
Splenic aspirate ,[object Object],[object Object],[object Object]
Leishmaniasis: treatment ,[object Object],[object Object],[object Object]
 
Remember.. ,[object Object],[object Object],[object Object],[object Object]
Case 7 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Case 8 ,[object Object],[object Object]
Cases 7 & 8 ,[object Object],[object Object]
AIDS Patient
AIDS Patient
Toxoplasma gondii cyst in brain tissue with H & E stain (100x)
For the businessman… ,[object Object],[object Object],[object Object]
Transmission ,[object Object],[object Object],[object Object]
Toxoplasma gondii ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Toxoplasma gondii: Immunocompetent hosts ,[object Object],[object Object],[object Object],[object Object],[object Object]
Toxoplasma gondii: Immunocompromised hosts ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Toxoplasma gondii: Clinical manifestations ,[object Object],[object Object],[object Object],[object Object],[object Object]
Toxoplasma gondii: Clinical manifestations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Toxoplasma gondii: diagnosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Toxoplasma gondii: Treatment ,[object Object],[object Object],[object Object],[object Object]
Toxoplasma gondii: Treatment ,[object Object],[object Object],[object Object],[object Object],[object Object]
Case 22 ,[object Object],[object Object],[object Object],[object Object],[object Object]
Thick smear
Thin smear Maltese cross
Diagnosis??
Babesiosis ,[object Object],[object Object],[object Object]
Babesiosis ,[object Object],[object Object],[object Object],[object Object],[object Object]
Babesiosis ,[object Object]
Babesiosis ,[object Object],[object Object],[object Object],[object Object]
Case 9 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Diagnosis?
Ascaris lumbricoides ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Effects of Adult Ascaris Worms ,[object Object],[object Object],[object Object],[object Object],[object Object]
Ascaris lumbricoides Diagnosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Case 10 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
 
Diagnosis?
Enterobius (Pinworm) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],Case 11
On the day of admission… ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Diagnosis
Strongyloides: Crucial Aspects of Life Cycle ,[object Object],[object Object],[object Object],[object Object]
Disseminated Strongyloidiasis ,[object Object],[object Object],[object Object],[object Object]
Summary—Clinical Findings ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Summary—Clinical Findings ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Summary-Clinical Findings ,[object Object],[object Object]
Case 12 ,[object Object],[object Object],[object Object],[object Object],[object Object]
 
Diagnosis?
 
Hookworm ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
Case 13 ,[object Object],[object Object],[object Object],[object Object],[object Object]
 
Diagnosis?
Trichuris trichiura (Whipworm) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
 
Case 14 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Case 15 ,[object Object],[object Object],[object Object]
 
Diagnosis ?
Cutaneous Larva Migrans ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Cutaneous larva migrans (creeping eruption) ,[object Object],[object Object],[object Object],[object Object]
Cutaneous larva migrans (creeping eruption) ,[object Object]
Cutaneous larva migrans (creeping eruption) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
Visceral Larva Migrans ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Case 17 ,[object Object],[object Object],[object Object],[object Object],[object Object]
Case 17 ,[object Object],[object Object],[object Object],[object Object]
 
Chronic intestinal schistosomiasis
Case 17 ,[object Object],[object Object]
Schistosomiasis: Epidemiology and life cycle ,[object Object],[object Object],[object Object]
Schistosomiasis: Epidemiology and life cycle ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Schistosomiasis: Clinical manifestations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Chronic Schistosomiasis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Schistosomiasis: Diagnosis and Treatment ,[object Object],[object Object],[object Object],[object Object]
 
S. mansoni Stool S. haematobium Urine S. japonicum
Case 18 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Diagnosis?
Investigations ,[object Object],[object Object]
Blood smear
African trypanosomiasis Trypanosoma brucei gambiense
Tsetse fly
Treatment ,[object Object],[object Object]
Case 19 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Diagnosis?
Blood smear
Reduviid bug (assassin bug)
Chagas disease: Clinical manifestations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Chagas disease: Diagnosis and treatment ,[object Object],[object Object],[object Object]
Chagas Disease ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Case 20 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Diagnosis?
Taenia saginata ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Beef Tapeworm
Treatment ,[object Object],[object Object],[object Object]
Tapeworms (Cestodes) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Case 21 ,[object Object],[object Object],[object Object],[object Object]
Case 21 ,[object Object],[object Object],[object Object],[object Object]
 
Case 21 ,[object Object],[object Object]
Cystercercosis ,[object Object],[object Object],[object Object],[object Object]
Cystercercosis ,[object Object],[object Object]
Cysticercosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Cysticercosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Cysticercosis ,[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
Case 21 ,[object Object],[object Object]
Classification of Parasitic Diseases ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
General rules of treatment ,[object Object],[object Object]
General rules of treatment of metazoa Nematodes Intestinal Mebendazole or Albendazole Tissue Albendazole Filiariae Ivermectin, doxycycline Cestodes Praziquantel, Albendazole, Niclosamide Trematode Praziquantel Ectoparasites Permethrin, Ivermectin
This is just the beginning of a great adventure in infectious diseases Sine qua non : history and physical examination
Thank you Lennox K. Archibald, MD, PhD, FRCP [email_address]

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